| NPI | 1902806771 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: WA 00021300) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: ID M-15965) |
| Enumeration Date | 2005-07-22 |
| Last Update Date | 2025-12-19 |