| NPI | 1316998354 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: WA MD00027639) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: CO 37360) |
| Enumeration Date | 2006-05-15 |
| Last Update Date | 2021-05-25 |