| NPI | 1114980232 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: CO 051282) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MN 29354) |
| Enumeration Date | 2006-04-10 |
| Last Update Date | 2015-02-17 |