| NPI | 1366407181 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: WA MD00022856) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: OR MD164782) |
| Enumeration Date | 2006-04-18 |
| Last Update Date | 2021-03-24 |