| NPI | 1508027632 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: CO 56170) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: ID M-10856) |
| Enumeration Date | 2008-06-20 |
| Last Update Date | 2021-08-30 |