| NPI | 1396765087 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: OR MD21810) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: WA MD00041139) |
| Enumeration Date | 2006-07-19 |
| Last Update Date | 2021-03-15 |