| NPI | 1093903700 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: OR MD165560) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: WA MD60094853) |
| Enumeration Date | 2007-10-09 |
| Last Update Date | 2026-01-15 |