| NPI | 1093912990 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: CO 50527) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MA 243938) |
| Enumeration Date | 2007-07-03 |
| Last Update Date | 2013-12-06 |