| NPI | 1528449642 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: WA OP61676957) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NV DO2685) |
| Enumeration Date | 2015-06-15 |
| Last Update Date | 2025-07-15 |