| NPI | 1467683110 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: OR MD222633) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: WA MD61446335) |
| Enumeration Date | 2009-07-29 |
| Last Update Date | 2025-01-02 |