NPI | 1124287321 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 207Q00000X Family Medicine (Licence: OR MD150934) |
Additional Taxonomies | 207Q00000X Family Medicine (Licence: WA MD60018029) |
Enumeration Date | 2008-06-03 |
Last Update Date | 2020-04-22 |