| NPI | 1326154139 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: WA MD00041659) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: WI 41043) |
| 207Q00000X Family Medicine (Licence: VA 0101057319) | |
| Enumeration Date | 2006-08-22 |
| Last Update Date | 2025-05-14 |