| NPI | 1922480219 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: WA MD61601930) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: WY 11157A) |
| 207Q00000X Family Medicine (Licence: WY 062-T1) | |
| 207Q00000X Family Medicine (Licence: WA MD61417606) | |
| Enumeration Date | 2015-06-23 |
| Last Update Date | 2024-10-17 |