| NPI | 1285662957 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: AR E-3759) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: CO DR-49601) |
| 207QS0010X Family Medicine, Sports Medicine (Licence: AR E-3759) | |
| Enumeration Date | 2006-06-29 |
| Last Update Date | 2015-03-02 |