| NPI | 1881128353 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: UT 10939795-1204) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: WA OP61065129) |
| Enumeration Date | 2017-04-11 |
| Last Update Date | 2025-11-24 |