| 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 |