| NPI | 1588706568 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: WA OP61645856) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NE 514) |
| Enumeration Date | 2007-02-13 |
| Last Update Date | 2025-05-30 |