| NPI | 1053422527 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: WA MD60580705) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: OR MD173885) |
| Enumeration Date | 2006-08-31 |
| Last Update Date | 2019-12-20 |