| NPI | 1972162915 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: CA 20A20411) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: CO DR.0074972) |
| 207Q00000X Family Medicine (Licence: WY 16301A) | |
| Enumeration Date | 2019-06-12 |
| Last Update Date | 2026-02-25 |