| NPI | 1477294973 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: OR DO224527) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: WA OP61671390) |
| Enumeration Date | 2022-04-06 |
| Last Update Date | 2025-07-16 |