| NPI | 1184696668 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: CO 53560) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: MT 8805) |
| 207Q00000X Family Medicine (Licence: MT 8805) | |
| Enumeration Date | 2006-02-07 |
| Last Update Date | 2016-08-11 |