| NPI | 1942262118 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: WA MD00047496) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: WY 7139A) |
| Enumeration Date | 2006-04-04 |
| Last Update Date | 2020-12-17 |