| NPI | 1972843787 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: WA 60325378) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: CO DR.0067329) |
| Enumeration Date | 2013-02-15 |
| Last Update Date | 2022-06-08 |