| NPI | 1972098606 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: WA OP61194203) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MI 5101024070) |
| Enumeration Date | 2018-06-26 |
| Last Update Date | 2023-01-09 |