| NPI | 1932216751 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: OR MD198698) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: WA MD00034602) |
| Enumeration Date | 2006-08-25 |
| Last Update Date | 2020-09-14 |