| NPI | 1356342364 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NV DO1423) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: CO 38165) |
| Enumeration Date | 2005-08-02 |
| Last Update Date | 2023-04-06 |