| NPI | 1922160712 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: HI MD-10556) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: WA MD60731438) |
| Enumeration Date | 2006-12-15 |
| Last Update Date | 2022-02-14 |