| NPI | 1043772486 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: WI 81212) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: WA BC61354364) |
| 207Q00000X Family Medicine (Licence: CO DR.0065617) | |
| Enumeration Date | 2019-04-04 |
| Last Update Date | 2023-02-23 |