| NPI | 1396780144 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: WI 48225) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: CO DR.0034837) |
| Enumeration Date | 2006-06-17 |
| Last Update Date | 2022-02-07 |