| NPI | 1801162656 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: WA OP61178958) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: OR DO171109) |
| Enumeration Date | 2012-03-27 |
| Last Update Date | 2021-10-22 |