| NPI | 1447787833 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: OR 199364) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: WA MD60994259) |
| Enumeration Date | 2017-05-16 |
| Last Update Date | 2020-07-21 |