| NPI | 1841497211 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: OR MD156564) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: WA MD60137718) |
| 207Q00000X Family Medicine (Licence: MI TE090719) | |
| 207Q00000X Family Medicine (Licence: CO DR.0067315) | |
| Enumeration Date | 2007-06-29 |
| Last Update Date | 2022-05-04 |