| NPI | 1932172723 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: WA MD00034221) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: ID M-16631) |
| Enumeration Date | 2006-02-10 |
| Last Update Date | 2022-06-13 |