| NPI | 1093067357 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: WA OP61091315) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: CO DR0059801) |
| 207Q00000X Family Medicine (Licence: AK 8308) | |
| Enumeration Date | 2012-10-11 |
| Last Update Date | 2020-10-27 |