| NPI | 1104888783 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NM MD20060672) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: CO DR44193) |
| Enumeration Date | 2006-04-06 |
| Last Update Date | 2012-01-17 |