| NPI | 1891700308 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: OR MD11898) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: WA 61078819) |
| Enumeration Date | 2006-07-31 |
| Last Update Date | 2025-10-08 |