| NPI | 1316909310 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: WA OP60746838) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: CO 0056514) |
| 207Q00000X Family Medicine (Licence: FL OS7137) | |
| Enumeration Date | 2006-04-05 |
| Last Update Date | 2022-07-21 |