| NPI | 1760834204 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: AZ 66576) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: WA MD60916833) |
| Enumeration Date | 2016-07-08 |
| Last Update Date | 2023-03-14 |