| NPI | 1881035244 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: AR E-12263) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: WA ML 60375624) |
| 207Q00000X Family Medicine (Licence: OR MD175215) | |
| Enumeration Date | 2013-07-15 |
| Last Update Date | 2023-08-17 |