| NPI | 1558622902 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: WA MD60467034) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: CO DR.0068982) |
| Enumeration Date | 2012-06-01 |
| Last Update Date | 2022-12-22 |