| NPI | 1144509423 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: WA MD61095140) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: OR MD166137) |
| Enumeration Date | 2011-08-04 |
| Last Update Date | 2021-03-18 |