| NPI | 1447258124 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: CO 35570) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: VA 0101242948) |
| Enumeration Date | 2005-07-07 |
| Last Update Date | 2016-03-16 |