| NPI | 1366439770 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: CO DR0050392) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: TX J8233) |
| Enumeration Date | 2005-09-30 |
| Last Update Date | 2021-02-26 |