| NPI | 1477715266 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: WA OP61386615) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MI 5101019034) |
| Enumeration Date | 2008-07-02 |
| Last Update Date | 2025-11-04 |