| NPI | 1770745804 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: WA MD60385714) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: HI 15324) |
| Enumeration Date | 2008-06-30 |
| Last Update Date | 2020-06-24 |