| NPI | 1356488639 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: CO 50621) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: WA 60026184) |
| 207Q00000X Family Medicine (Licence: CA A102422) | |
| 207Q00000X Family Medicine (Licence: AZ 38066) | |
| Enumeration Date | 2007-01-30 |
| Last Update Date | 2018-04-27 |