| NPI | 1831202043 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: OR MD24247) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: WA MD60665697) |
| Enumeration Date | 2006-08-15 |
| Last Update Date | 2026-05-20 |