| NPI | 1811424401 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: OR MD216438) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: WA MD61456674) |
| Enumeration Date | 2017-05-15 |
| Last Update Date | 2023-10-24 |