| NPI | 1255998324 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: WA MD61037697) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: WA ML60973564) |
| 207Q00000X Family Medicine (Licence: OR MD209116) | |
| Enumeration Date | 2019-05-23 |
| Last Update Date | 2022-09-28 |