| NPI | 1982865739 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: WA MD60063868) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: CO DR.0067392) |
| Enumeration Date | 2008-06-24 |
| Last Update Date | 2022-12-08 |