| NPI | 1144761198 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: CA A151858) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: HI MD20709) |
| 207Q00000X Family Medicine (Licence: WA MD61051191) | |
| 207Q00000X Family Medicine (Licence: ME MD27820) | |
| Enumeration Date | 2017-03-09 |
| Last Update Date | 2025-03-17 |