| NPI | 1235193343 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: CO 35422) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: SC 907) |
| Enumeration Date | 2006-04-14 |
| Last Update Date | 2017-04-03 |