| NPI | 1114300936 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: CO DR.0060646) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: PA MT209745) |
| Enumeration Date | 2015-06-30 |
| Last Update Date | 2021-04-22 |