| NPI | 1780660175 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: WA MD00047504) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NE 22673) |
| 207Q00000X Family Medicine (Licence: OR MD27417) | |
| Enumeration Date | 2005-12-19 |
| Last Update Date | 2023-03-07 |