| NPI | 1104932888 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: CO 47105) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NY 228550) |
| Enumeration Date | 2006-08-22 |
| Last Update Date | 2021-04-20 |