| NPI | 1083611396 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: WA OP00002174) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: OR DO23242) |
| Enumeration Date | 2005-06-30 |
| Last Update Date | 2020-01-28 |