| NPI | 1306891122 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: WA MD00049099) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: OR MD29366) |
| 207Q00000X Family Medicine (Licence: MD D0062887) | |
| Enumeration Date | 2006-05-23 |
| Last Update Date | 2023-09-05 |