| NPI | 1770102782 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: WA MD61435275) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: OR MD216222) |
| Enumeration Date | 2020-04-09 |
| Last Update Date | 2025-12-15 |