| NPI | 1447387477 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: CA A72328) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: CO 39948) |
| Enumeration Date | 2007-02-27 |
| Last Update Date | 2022-07-11 |