| NPI | 1417186982 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: WA MD60807713) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: CO 0053036) |
| Enumeration Date | 2009-07-06 |
| Last Update Date | 2022-08-16 |