| NPI | 1144322694 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: WA wa md00017356) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: OR or md17059) |
| Enumeration Date | 2006-09-05 |
| Last Update Date | 2007-07-08 |