| NPI | 1548273022 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: OR MD29299) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: WA MD00016090) |
| Enumeration Date | 2006-08-14 |
| Last Update Date | 2021-01-29 |