| NPI | 1386959989 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: AZ 54601) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: WA ML60155828) |
| Enumeration Date | 2010-08-09 |
| Last Update Date | 2026-06-18 |