| NPI | 1639308661 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: WA MD60529478) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: OR MD163909) |
| Enumeration Date | 2009-07-12 |
| Last Update Date | 2015-07-07 |