| NPI | 1487739298 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: WA MD00031331) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: CO DR.0067844) |
| Enumeration Date | 2006-10-27 |
| Last Update Date | 2022-04-14 |