| NPI | 1023086659 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: WA 1508) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: OR DO219176) |
| Enumeration Date | 2006-03-09 |
| Last Update Date | 2025-09-25 |