| NPI | 1538783154 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: WA MD61321643) |
| Additional Taxonomies | 2083C0008X Preventive Medicine, Clinical Informatics Specialist (Licence: WA MD61321643) |
| Enumeration Date | 2020-05-29 |
| Last Update Date | 2025-09-17 |