| NPI | 1992091235 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: WA MD60752858) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: WA 60752858) |
| 207Q00000X Family Medicine (Licence: MI 4301102824) | |
| Enumeration Date | 2011-06-24 |
| Last Update Date | 2021-01-18 |