| NPI | 1952646960 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: WA OP61516181) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: CA 20A12531) |
| 207Q00000X Family Medicine (Licence: OR DO195971) | |
| Enumeration Date | 2012-12-02 |
| Last Update Date | 2025-07-11 |