| NPI | 1720071491 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: CO 51986) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: WA md00038006) |
| Enumeration Date | 2005-08-26 |
| Last Update Date | 2021-06-21 |