| NPI | 1396853610 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: CO DR0053194) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: WI 41373) |
| Enumeration Date | 2006-08-27 |
| Last Update Date | 2014-05-28 |