| NPI | 1407299340 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NC 2022-02808) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: VA 0101273414) |
| 207Q00000X Family Medicine (Licence: CO DR.0069958) | |
| 207Q00000X Family Medicine (Licence: AZ 64652) | |
| Enumeration Date | 2013-04-10 |
| Last Update Date | 2024-05-31 |