| NPI | 1922193069 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: WA MD60186297) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MT 7716) |
| Enumeration Date | 2006-10-04 |
| Last Update Date | 2024-05-07 |