| NPI | 1346291598 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: CA A96786) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: WA MD70026019) |
| 207Q00000X Family Medicine (Licence: OR MD226619) | |
| Enumeration Date | 2006-05-12 |
| Last Update Date | 2026-04-30 |