| NPI | 1548581853 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: CA A132032) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: OR MD227109) |
| 207Q00000X Family Medicine (Licence: WA MD70032159) | |
| Enumeration Date | 2010-06-21 |
| Last Update Date | 2026-04-30 |