| NPI | 1487966107 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: OR MD185193) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: WA MD60328795) |
| Enumeration Date | 2010-07-10 |
| Last Update Date | 2023-08-07 |