| NPI | 1518194687 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: UT 8631872-1205) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: WA MD60243907) |
| Enumeration Date | 2009-06-16 |
| Last Update Date | 2026-06-09 |