| NPI | 1619982402 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: WA OP00002061) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: OR DO28168) |
| Enumeration Date | 2006-07-30 |
| Last Update Date | 2011-12-12 |