| NPI | 1275559940 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: OR MD25602) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: WA MD00045134) |
| Enumeration Date | 2006-07-14 |
| Last Update Date | 2020-10-19 |