| NPI | 1831539220 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: ID O-0853) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: WA OP61523007) |
| Enumeration Date | 2013-06-28 |
| Last Update Date | 2024-11-18 |