| NPI | 1215968045 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: CO DR.0073268) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: WA OP61556804) |
| 207Q00000X Family Medicine (Licence: OR DO221842) | |
| 207Q00000X Family Medicine (Licence: PA OS024313) | |
| Enumeration Date | 2006-07-06 |
| Last Update Date | 2024-10-22 |