| NPI | 1487674818 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NM A-1394-07) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: CO 31653) |
| Enumeration Date | 2006-07-20 |
| Last Update Date | 2007-07-08 |