| NPI | 1720091267 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: WA WA MD 00022824) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: OR OR MD 15544) |
| Enumeration Date | 2006-08-14 |
| Last Update Date | 2007-07-16 |