| NPI | 1093724882 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: CO 52148) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: TN DO01675) |
| Enumeration Date | 2006-08-08 |
| Last Update Date | 2021-04-09 |