| NPI | 1780900969 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: OR MD181846) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: WA MD60385940) |
| Enumeration Date | 2010-04-14 |
| Last Update Date | 2021-11-30 |