| NPI | 1316921109 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: OH 35055568) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: CO DR.0062503) |
| Enumeration Date | 2005-12-05 |
| Last Update Date | 2019-08-02 |