| NPI | 1336284108 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: CO 0051951) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: IN 01061862A) |
| Enumeration Date | 2007-02-20 |
| Last Update Date | 2015-11-23 |