| NPI | 1801833645 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: ID O-303) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: WY 6998A) |
| 207Q00000X Family Medicine (Licence: WA OP60518627) | |
| 207Q00000X Family Medicine (Licence: OR DO-162239) | |
| Enumeration Date | 2006-06-01 |
| Last Update Date | 2025-08-27 |