| NPI | 1558949636 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: WA OP61564044) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: GA 113368) |
| Enumeration Date | 2021-03-31 |
| Last Update Date | 2026-06-17 |