| NPI | 1235234303 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: WA MD00036620) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: HI MD-12545) |
| Enumeration Date | 2006-09-13 |
| Last Update Date | 2026-04-23 |