| NPI | 1801022389 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: WA MD60425466) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: AK 7548) |
| 207Q00000X Family Medicine (Licence: AK 6569) | |
| Enumeration Date | 2009-06-10 |
| Last Update Date | 2018-05-09 |