| NPI | 1336761808 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: OR PG199699) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: WA DO.OP.70125995) |
| Enumeration Date | 2020-05-07 |
| Last Update Date | 2026-07-30 |