| NPI | 1417538315 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: WA MD61593749) |
| Additional Taxonomies | 207V00000X Obstetrics & Gynecology (Licence: WA MD61593749) |
| Enumeration Date | 2021-04-21 |
| Last Update Date | 2026-06-09 |