| NPI | 1295762292 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: IA MD-45058) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: TN 54278) |
| 207Q00000X Family Medicine (Licence: CO 31189) | |
| Enumeration Date | 2006-06-26 |
| Last Update Date | 2020-01-10 |