| NPI | 1306983549 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: WA MD00019032) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: OR 34978) |
| 207Q00000X Family Medicine (Licence: CA G47036) | |
| Enumeration Date | 2007-01-30 |
| Last Update Date | 2010-06-25 |