| NPI | 1821040247 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: WA MD00037693) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: ID M9219) |
| Enumeration Date | 2006-05-16 |
| Last Update Date | 2023-10-05 |