| NPI | 1376650408 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: CO DR.0040200) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: TX L4793) |
| Enumeration Date | 2006-08-24 |
| Last Update Date | 2019-07-17 |