| NPI | 1518198233 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: WA 61158181) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: OR 173717) |
| 207Q00000X Family Medicine (Licence: OK 27175) | |
| Enumeration Date | 2009-07-29 |
| Last Update Date | 2021-09-27 |