| NPI | 1477663227 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: WA WA MD00020913) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: OR OR MD13777) |
| Enumeration Date | 2006-08-30 |
| Last Update Date | 2022-02-04 |