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 |