| NPI | 1871145193 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: WA MD61295216) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: ND RL15864) |
| 207Q00000X Family Medicine (Licence: OR MD210455) | |
| Enumeration Date | 2019-07-16 |
| Last Update Date | 2026-05-28 |