| NPI | 1346215266 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: CO 37040) |
| Additional Taxonomies | 207QA0505X Family Medicine Adult Medicine (Licence: CO 37040) |
| Enumeration Date | 2006-02-22 |
| Last Update Date | 2020-03-10 |