| NPI | 1831400126 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: OR MD164204) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: WA ML60154176) |
| Enumeration Date | 2010-07-01 |
| Last Update Date | 2019-08-07 |