| NPI | 1396797965 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: CO 25050) |
| Additional Taxonomies | 207V00000X Obstetrics & Gynecology (Licence: CO 025050) |
| Enumeration Date | 2006-05-16 |
| Last Update Date | 2007-07-08 |