| NPI | 1023133527 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: CA A91940) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: OR MD227110) |
| 207Q00000X Family Medicine (Licence: WA MD70032208) | |
| Enumeration Date | 2007-03-21 |
| Last Update Date | 2026-06-10 |