| NPI | 1760758684 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MD D0079154) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: WA MD61091159) |
| Enumeration Date | 2012-03-25 |
| Last Update Date | 2021-06-07 |