| NPI | 1770794216 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NV 16847) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: WA MD60158622) |
| Enumeration Date | 2007-05-25 |
| Last Update Date | 2024-11-19 |