| NPI | 1235124520 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: OR MD183183) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: CO A773420) |
| Enumeration Date | 2005-09-13 |
| Last Update Date | 2020-10-14 |