| NPI | 1144318700 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: AZ 23763) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: CO 36638) |
| Enumeration Date | 2006-10-10 |
| Last Update Date | 2019-07-15 |