| NPI | 1750794731 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: AZ 58752) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: WA MD60733269) |
| Enumeration Date | 2014-06-06 |
| Last Update Date | 2026-05-05 |