| NPI | 1083603088 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: CO DR32010) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: CA G056273) |
| Enumeration Date | 2005-10-21 |
| Last Update Date | 2010-12-20 |