NPI | 1225113236 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 207Q00000X Family Medicine (Licence: OR MD195896) |
Additional Taxonomies | 207Q00000X Family Medicine (Licence: WA MD00042903) |
Enumeration Date | 2006-10-26 |
Last Update Date | 2025-02-27 |