| NPI | 1144516204 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: OR DO158384) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: CA 20A15969) |
| 207Q00000X Family Medicine (Licence: OR DO154384) | |
| Enumeration Date | 2011-06-27 |
| Last Update Date | 2021-09-10 |