| NPI | 1023334109 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: CO DR.0060475) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: OH 35.121889) |
| Enumeration Date | 2010-04-14 |
| Last Update Date | 2021-03-29 |