| NPI | 1730261785 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: WA OP 60015374) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: CO 42514) |
| Enumeration Date | 2006-10-19 |
| Last Update Date | 2019-12-17 |