| NPI | 1043324262 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: WA wa md00034576) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: OR or md12713) |
| Enumeration Date | 2006-08-17 |
| Last Update Date | 2007-07-08 |