| NPI | 1629073598 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: CO DR.0030471) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: WA MD00027907) |
| Enumeration Date | 2005-06-16 |
| Last Update Date | 2022-09-21 |