| NPI | 1356563837 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: WA MD6131378) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MI 4301094574) |
| 207Q00000X Family Medicine (Licence: OR MD219105) | |
| 207Q00000X Family Medicine (Licence: MI L1585028) | |
| Enumeration Date | 2007-05-03 |
| Last Update Date | 2026-06-18 |