| NPI | 1982850483 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: WA OP60469602) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: OR DO155128) |
| Enumeration Date | 2008-08-15 |
| Last Update Date | 2021-04-21 |