| NPI | 1104898915 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: CO 55525) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: WI 42443) |
| Enumeration Date | 2006-02-06 |
| Last Update Date | 2018-08-17 |