| NPI | 1033591375 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: WA MD70039642) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: WY 065-T1) |
| Enumeration Date | 2015-06-23 |
| Last Update Date | 2026-05-04 |