| NPI | 1346530573 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: WA 60393362) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: OR MD180593) |
| Enumeration Date | 2011-04-08 |
| Last Update Date | 2021-09-28 |