| NPI | 1104820570 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: WA OP61495864) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: CO 37281) |
| Enumeration Date | 2005-06-13 |
| Last Update Date | 2024-10-21 |