| NPI | 1467653766 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: OR MD188472) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: WA MD00040616) |
| Enumeration Date | 2007-05-31 |
| Last Update Date | 2019-10-11 |