NPI | 1487660973 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 207Q00000X Family Medicine (Licence: WA MD00018314) |
Additional Taxonomies | 207Q00000X Family Medicine (Licence: OR MD14497) |
Enumeration Date | 2006-08-01 |
Last Update Date | 2009-04-23 |