| NPI | 1386026086 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: WA MD61151531) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: CA 147217) |
| 207Q00000X Family Medicine (Licence: OR MD188654) | |
| Enumeration Date | 2015-06-18 |
| Last Update Date | 2024-05-03 |