| NPI | 1255323754 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: WA MD00013986) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: OR MD15177) |
| Enumeration Date | 2005-08-19 |
| Last Update Date | 2008-01-31 |