| NPI | 1578126561 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: AK 913315) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: WA MD.MD61653822) |
| Enumeration Date | 2019-04-16 |
| Last Update Date | 2025-08-23 |