| NPI | 1861999492 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: WI 76589) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: WA 60942952) |
| Enumeration Date | 2018-04-10 |
| Last Update Date | 2023-12-27 |