| NPI | 1598051633 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: WA MD60900258) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: FL ME 117286) |
| 207Q00000X Family Medicine (Licence: CO DR.0054843) | |
| 207Q00000X Family Medicine (Licence: GA 4838) | |
| Enumeration Date | 2011-06-28 |
| Last Update Date | 2021-05-03 |