| NPI | 1548520869 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: OR DO171244) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: WA OP60798348) |
| Enumeration Date | 2012-05-21 |
| Last Update Date | 2023-06-22 |