| NPI | 1972619989 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: OR OR DO09677) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: WA WA OP00000980) |
| Enumeration Date | 2006-08-22 |
| Last Update Date | 2007-07-08 |