| NPI | 1265546014 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: LA MD 203009) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MS 19473) |
| 207Q00000X Family Medicine (Licence: CO DR.0059785) | |
| Enumeration Date | 2006-08-18 |
| Last Update Date | 2021-11-24 |