| NPI | 1831621770 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: ME md27040) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: WA MD60976961) |
| Enumeration Date | 2017-03-30 |
| Last Update Date | 2023-08-21 |