NPI | 1154345429 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 207Q00000X Family Medicine (Licence: CO 39814) |
Additional Taxonomies | 207Q00000X Family Medicine (Licence: NC 200501550) |
Enumeration Date | 2006-07-27 |
Last Update Date | 2021-04-27 |