| NPI | 1811074834 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: WA MD60435859) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: ID M-13178) |
| Enumeration Date | 2006-11-01 |
| Last Update Date | 2021-09-20 |