| NPI | 1407204209 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: OR MD225209) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: WA MD60962689) |
| Enumeration Date | 2016-06-02 |
| Last Update Date | 2026-02-03 |