| NPI | 1760720304 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207QA0505X Family Medicine, Adult Medicine (Licence: CO 53691) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: WA MD60732585) |
| Enumeration Date | 2013-01-16 |
| Last Update Date | 2018-11-12 |