| NPI | 1811047731 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: WA MD00047122) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: OR MD26891) |
| Enumeration Date | 2007-01-11 |
| Last Update Date | 2008-03-17 |