| NPI | 1386175891 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: WA MD60970595) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: OR MD219118) |
| Enumeration Date | 2017-03-26 |
| Last Update Date | 2024-03-21 |