| NPI | 1457055436 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: OR MD232415) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: WA MD.MD.70163144) |
| Enumeration Date | 2023-03-27 |
| Last Update Date | 2026-09-10 |