| NPI | 1104846351 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: OR MD191277) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: WA MD00040371) |
| Enumeration Date | 2006-07-20 |
| Last Update Date | 2019-06-06 |