| NPI | 1760681761 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: CO 50669) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: ID MR-0939) |
| 207Q00000X Family Medicine (Licence: WA MD60167455) | |
| Enumeration Date | 2007-07-11 |
| Last Update Date | 2019-01-09 |