| NPI | 1952715435 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: WA OP70047943) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NC 2022-01887) |
| Enumeration Date | 2014-06-12 |
| Last Update Date | 2025-12-19 |