| NPI | 1932634706 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: WA MD60963491) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: WA ML60756123) |
| 207Q00000X Family Medicine (Licence: WA MD60963500) | |
| Enumeration Date | 2017-04-28 |
| Last Update Date | 2021-10-05 |