| NPI | 1205198959 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: TN 51023) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: WA MD61089183) |
| Enumeration Date | 2012-06-08 |
| Last Update Date | 2026-02-27 |