| NPI | 1720408479 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: OR MD189798) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: CO DR.0056225) |
| 207Q00000X Family Medicine (Licence: WA MD61336231) | |
| Enumeration Date | 2014-04-21 |
| Last Update Date | 2023-11-21 |