| NPI | 1952694549 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: WA MD60771670) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: UT 8438943-1205) |
| Enumeration Date | 2011-05-16 |
| Last Update Date | 2023-05-23 |