| NPI | 1871642082 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: AZ 51196) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: WA MD00020253) |
| Enumeration Date | 2007-01-09 |
| Last Update Date | 2023-06-30 |