| NPI | 1013144740 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: WA op60287355) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: OR DO150840) |
| Enumeration Date | 2009-06-21 |
| Last Update Date | 2024-06-25 |