| NPI | 1952051138 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: WA MD.70013272) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: CO DR.0072254) |
| 207Q00000X Family Medicine (Licence: OR MD226746) | |
| Enumeration Date | 2022-03-28 |
| Last Update Date | 2025-07-11 |