| NPI | 1881777340 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: WA OP00002167) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: AZ 4141) |
| Enumeration Date | 2006-10-20 |
| Last Update Date | 2025-02-24 |