| NPI | 1487966750 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MS 22699) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: CO 65255) |
| Enumeration Date | 2010-07-02 |
| Last Update Date | 2022-09-01 |