| NPI | 1407842487 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: OR DO21884) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: WA OP60758493) |
| Enumeration Date | 2005-09-23 |
| Last Update Date | 2026-03-18 |