| NPI | 1346290871 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: WA MD60652458) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: CO DR.0067366) |
| 207R00000X Internal Medicine (Licence: OR MD21230) | |
| Enumeration Date | 2006-05-12 |
| Last Update Date | 2022-06-14 |