| NPI | 1902836935 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: WA MD60041316) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NE 22777) |
| Enumeration Date | 2006-07-04 |
| Last Update Date | 2021-03-30 |