| NPI | 1558374538 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: WA MD00021715) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: OR MD23802) |
| Enumeration Date | 2006-08-14 |
| Last Update Date | 2007-07-08 |