| NPI | 1225234552 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: CO 49034) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: PA OS013860) |
| Enumeration Date | 2007-06-24 |
| Last Update Date | 2021-05-10 |