| NPI | 1104963842 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: CO 29184) |
| Additional Taxonomies | 207RA0000X Internal Medicine, Adolescent Medicine (Licence: CO 29184) |
| Enumeration Date | 2007-01-31 |
| Last Update Date | 2014-12-05 |