| NPI | 1477565026 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: OR MD204079) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: WA 14461) |
| 207Q00000X Family Medicine (Licence: MN 66750) | |
| Enumeration Date | 2006-08-12 |
| Last Update Date | 2021-05-11 |