| NPI | 1386644417 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: WA MD 60173771) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MD D0054571) |
| 207Q00000X Family Medicine (Licence: OR MD15286) | |
| Enumeration Date | 2005-07-29 |
| Last Update Date | 2022-02-04 |