| NPI | 1750478558 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: WA MD00032604) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: OR MD18943) |
| Enumeration Date | 2006-10-05 |
| Last Update Date | 2007-07-17 |