| NPI | 1275279994 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: ND RL18460) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: WA MD61669425) |
| Enumeration Date | 2022-05-05 |
| Last Update Date | 2025-07-24 |