| NPI | 1760813075 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: WA OP60670623) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: PA OT015490) |
| 207Q00000X Family Medicine (Licence: WA TO60695541) | |
| Enumeration Date | 2013-12-12 |
| Last Update Date | 2021-05-04 |