| NPI | 1679987457 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: WA MD61378145) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: KS 94-08450) |
| 207Q00000X Family Medicine (Licence: OR MD185613) | |
| Enumeration Date | 2014-06-19 |
| Last Update Date | 2025-05-15 |