| NPI | 1326158684 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: CO 36825) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: WY 7216A) |
| Enumeration Date | 2006-08-30 |
| Last Update Date | 2018-07-25 |