| NPI | 1538149794 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: CO DR.0052634) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: WA op00002054) |
| 207Q00000X Family Medicine (Licence: OR DO23435) | |
| Enumeration Date | 2006-01-21 |
| Last Update Date | 2018-07-03 |