| NPI | 1770727224 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: WA MD60391046) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: OR MD160396) |
| Enumeration Date | 2009-04-28 |
| Last Update Date | 2022-02-04 |