| NPI | 1568951812 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NY 310444) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: WA OP61103103) |
| Enumeration Date | 2018-05-02 |
| Last Update Date | 2025-04-29 |