| NPI | 1285084012 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: WA MD61181719) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: PA MD468811) |
| Enumeration Date | 2016-06-13 |
| Last Update Date | 2025-10-07 |