| NPI | 1902967243 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: ID O-0589) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: WA BF4836978) |
| Enumeration Date | 2006-12-12 |
| Last Update Date | 2018-05-16 |