| NPI | 1225721228 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: WA 70104203) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: ID 7261479) |
| Enumeration Date | 2023-05-26 |
| Last Update Date | 2026-06-03 |