| NPI | 1437125473 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MI 5101012723) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: CO 50712) |
| Enumeration Date | 2006-02-28 |
| Last Update Date | 2013-03-11 |