| NPI | 1821523697 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MT 126912) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: WA OP60959529) |
| 207Q00000X Family Medicine (Licence: WA OL60756453) | |
| Enumeration Date | 2017-04-28 |
| Last Update Date | 2023-11-14 |