| NPI | 1891918629 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: WA 00028927) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: ID M-11013) |
| Enumeration Date | 2007-04-10 |
| Last Update Date | 2019-02-04 |