| NPI | 1083235675 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: WA MD61376660) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: OR MD214070) |
| Enumeration Date | 2020-05-05 |
| Last Update Date | 2023-08-29 |