| NPI | 1013022995 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MI 4301051647) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NM NM2007-0112) |
| 207Q00000X Family Medicine (Licence: CO 42532) | |
| Enumeration Date | 2006-08-20 |
| Last Update Date | 2022-09-13 |