| NPI | 1104288257 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: WA IMLC.MD.61278391) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MS 26938) |
| Enumeration Date | 2016-03-27 |
| Last Update Date | 2026-08-20 |