| NPI | 1821226051 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NC 2014-01766) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: CA A125431) |
| 207Q00000X Family Medicine (Licence: WA MD60332163) | |
| 207Q00000X Family Medicine (Licence: CO 49461) | |
| Enumeration Date | 2009-06-25 |
| Last Update Date | 2022-02-11 |