| NPI | 1700831823 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: WA OP00002272) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: OR DO26062) |
| Enumeration Date | 2006-05-24 |
| Last Update Date | 2023-12-06 |