NPI | 1225241177 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 207Q00000X Family Medicine (Licence: WA MD00019433) |
Additional Taxonomies | 207Q00000X Family Medicine (Licence: OR MD13449) |
Enumeration Date | 2007-05-08 |
Last Update Date | 2007-07-08 |