| NPI | 1386931426 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: WA OP61658852) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NE 974) |
| Enumeration Date | 2011-07-08 |
| Last Update Date | 2025-07-02 |