| NPI | 1447652177 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: WA OP61091349) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: AZ 2355) |
| Enumeration Date | 2014-09-25 |
| Last Update Date | 2026-07-23 |