| NPI | 1932359551 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: WA MD60041276) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: WA Pending) |
| 207Q00000X Family Medicine (Licence: NY 277759) | |
| Enumeration Date | 2008-09-19 |
| Last Update Date | 2023-02-03 |