| NPI | 1215020797 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: CO 50386) |
| Additional Taxonomies | 208D00000X General Practice (Licence: MT 11161) |
| Enumeration Date | 2006-10-02 |
| Last Update Date | 2011-10-22 |