| NPI | 1053369900 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NE 19921) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: CO 47278) |
| Enumeration Date | 2006-05-04 |
| Last Update Date | 2016-07-15 |