| NPI | 1770794885 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: VA 0102202415) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: WA OP60025783) |
| Enumeration Date | 2007-05-24 |
| Last Update Date | 2022-08-24 |