| NPI | 1538850896 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: AK 210824) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: WA MD70123318) |
| Enumeration Date | 2023-05-17 |
| Last Update Date | 2026-08-11 |