| NPI | 1174596381 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: CO DR.0062904) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: PA MD023819E) |
| Enumeration Date | 2006-02-08 |
| Last Update Date | 2021-04-28 |