| NPI | 1972879153 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: WA MD60859652) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: OR MD176909) |
| Enumeration Date | 2012-04-01 |
| Last Update Date | 2018-10-08 |