| NPI | 1104943976 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: CO 46681) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: FL ME98263) |
| Enumeration Date | 2007-03-24 |
| Last Update Date | 2008-07-15 |