| NPI | 1225113236 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: OR MD195896) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: WA MD00042903) |
| Enumeration Date | 2006-10-26 |
| Last Update Date | 2026-08-05 |