| NPI | 1598144404 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207QS0010X Family Medicine, Sports Medicine (Licence: WA MD61505880) |
| Additional Taxonomies | 207QS0010X Family Medicine, Sports Medicine (Licence: OR MD188298) |
| 207Q00000X Family Medicine (Licence: WA MD61505880) | |
| Enumeration Date | 2015-05-26 |
| Last Update Date | 2024-08-15 |