| NPI | 1063630606 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: WA MD.60496901) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: OH 35.090940) |
| 207Q00000X Family Medicine (Licence: OR MD211624) | |
| Enumeration Date | 2007-04-20 |
| Last Update Date | 2023-08-18 |