| NPI | 1033340740 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: CO DR 0052085) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NY 234976) |
| 207Q00000X Family Medicine (Licence: WI 41314-020) | |
| Enumeration Date | 2009-07-29 |
| Last Update Date | 2021-03-16 |