| NPI | 1346224169 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: CO 27879) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: WI 41579) |
| Enumeration Date | 2005-12-05 |
| Last Update Date | 2016-08-24 |