| NPI | 1912016551 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: WA MD00027398) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: OR MD15624) |
| Enumeration Date | 2006-08-29 |
| Last Update Date | 2022-02-01 |