| NPI | 1801039649 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: WA MD60211392) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NM MD2020-1174) |
| Enumeration Date | 2009-04-09 |
| Last Update Date | 2021-02-18 |