| NPI | 1073702817 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: WA MD60627719) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: OR MD27877) |
| Enumeration Date | 2007-10-17 |
| Last Update Date | 2018-12-07 |