| NPI | 1891324489 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: OR DO214086) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: WA OP61402237) |
| Enumeration Date | 2020-04-06 |
| Last Update Date | 2023-09-08 |