| NPI | 1689012585 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: WA MD61242356) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: OR MD210120) |
| 207Q00000X Family Medicine (Licence: VA 0101256904) | |
| Enumeration Date | 2013-06-13 |
| Last Update Date | 2023-03-07 |