| NPI | 1932315702 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: OR DO214165) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: WA OP61381709) |
| 207Q00000X Family Medicine (Licence: WA OP61381709) | |
| 207R00000X Internal Medicine (Licence: OR DO214165) | |
| 207Q00000X Family Medicine (Licence: CA 20A9295) | |
| Enumeration Date | 2007-05-16 |
| Last Update Date | 2025-09-12 |