| NPI | 1619984143 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: WA OP60440021) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: WI 44658) |
| Enumeration Date | 2006-08-01 |
| Last Update Date | 2026-07-20 |