| NPI | 1295097004 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: CO 52378) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: CO 4236) |
| Enumeration Date | 2012-06-08 |
| Last Update Date | 2015-06-30 |