| NPI | 1033112271 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: OR MD17629) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: CO 31332) |
| Enumeration Date | 2005-05-23 |
| Last Update Date | 2011-09-03 |