| NPI | 1225135221 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: WA MD00046768) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: OR MD26965) |
| 208D00000X General Practice (Licence: WA MD00046768) | |
| Enumeration Date | 2006-09-20 |
| Last Update Date | 2023-06-09 |