| NPI | 1992141139 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: WA MD60572144) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: OH 35.129333) |
| 207Q00000X Family Medicine (Licence: WA ML60370962) | |
| Enumeration Date | 2013-05-15 |
| Last Update Date | 2025-11-07 |