| NPI | 1780752469 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: OR MD186714) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NM NM2007-0097) |
| 207Q00000X Family Medicine (Licence: CO 40961) | |
| 207Q00000X Family Medicine (Licence: WA MD00043473) | |
| 207Q00000X Family Medicine (Licence: ID M-11354) | |
| Enumeration Date | 2006-12-01 |
| Last Update Date | 2021-03-22 |