| NPI | 1215988142 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: CO 59740) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: WI 37371) |
| Enumeration Date | 2006-05-15 |
| Last Update Date | 2021-03-08 |