| NPI | 1568574549 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: WA MD00031237) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: OR 16355 MD) |
| Enumeration Date | 2006-08-31 |
| Last Update Date | 2022-02-04 |