| NPI | 1326206681 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: WA MD60027802) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: OR MD150135) |
| Enumeration Date | 2008-05-22 |
| Last Update Date | 2018-03-17 |