| NPI | 1619940194 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: OR MD181799) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: WA MD60742702) |
| 207Q00000X Family Medicine (Licence: NV 8243) | |
| Enumeration Date | 2006-02-07 |
| Last Update Date | 2026-05-04 |