| NPI | 1669819322 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: CO 68087) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: WA OP60674566) |
| 207Q00000X Family Medicine (Licence: NM A-2236-19) | |
| Enumeration Date | 2013-06-03 |
| Last Update Date | 2023-01-11 |