| NPI | 1497812358 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: WA MD00028563) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: CO DR.0067808) |
| Enumeration Date | 2007-01-02 |
| Last Update Date | 2022-04-14 |