| NPI | 1912526823 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NY 320887) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: WA MD61427720) |
| Enumeration Date | 2020-04-10 |
| Last Update Date | 2025-07-23 |