| NPI | 1437771169 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: WA MD61395175) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: ID MRM-1934) |
| Enumeration Date | 2020-05-15 |
| Last Update Date | 2025-09-10 |