| NPI | 1467035238 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: OR MD221817) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: WA MD61578733) |
| Enumeration Date | 2021-04-30 |
| Last Update Date | 2026-08-18 |