| NPI | 1467468132 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: OR MD27159) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: WA MD00038966) |
| Enumeration Date | 2006-08-01 |
| Last Update Date | 2021-03-25 |