| NPI | 1992093538 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: WA MD60824243) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: FL ME116980) |
| 207Q00000X Family Medicine (Licence: CO DR.0069721) | |
| Enumeration Date | 2011-07-18 |
| Last Update Date | 2024-02-13 |