| NPI | 1245210319 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: CO 39737) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MO 2007007781) |
| Enumeration Date | 2006-01-17 |
| Last Update Date | 2013-07-15 |