| NPI | 1316107477 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: OR MD171910) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: WA MD60111452) |
| Enumeration Date | 2008-06-12 |
| Last Update Date | 2025-11-12 |