| NPI | 1134115512 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: OR MD187100) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: WA MD00045971) |
| 207Q00000X Family Medicine (Licence: OR md25805) | |
| Enumeration Date | 2005-09-21 |
| Last Update Date | 2021-06-15 |