| NPI | 1841871035 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: WA MD61577223) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: WA 61163537) |
| Enumeration Date | 2021-04-19 |
| Last Update Date | 2024-10-11 |