| NPI | 1003836487 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: OR MD22545) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: WA MD00044589) |
| Enumeration Date | 2006-07-20 |
| Last Update Date | 2021-10-13 |