| NPI | 1861920746 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: CO DR.72639) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: WA MD61254051) |
| Enumeration Date | 2017-05-23 |
| Last Update Date | 2024-09-12 |