| NPI | 1689849697 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: DE C1-0009690) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: WA IMLC.MD.70159342) |
| Enumeration Date | 2008-04-30 |
| Last Update Date | 2026-09-02 |