| NPI | 1376707034 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: ID O-0583) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: WA OL20000133) |
| Enumeration Date | 2008-07-11 |
| Last Update Date | 2026-05-18 |