| NPI | 1821290636 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: WA MD60438798) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NH 13882) |
| Enumeration Date | 2007-06-04 |
| Last Update Date | 2020-12-09 |