| NPI | 1457592552 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: GA 076391) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: CO 39928) |
| Enumeration Date | 2009-03-19 |
| Last Update Date | 2016-07-27 |