| NPI | 1841342730 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: WA MD00035643) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: OR MD226457) |
| Enumeration Date | 2007-01-18 |
| Last Update Date | 2025-10-14 |