| NPI | 1346252152 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: OR MD202900) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: UT 7111834-1205) |
| 207Q00000X Family Medicine (Licence: WA MD 00049004) | |
| Enumeration Date | 2006-08-12 |
| Last Update Date | 2021-11-01 |