| NPI | 1558448118 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: CO 18992) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: CO 18992) |
| Enumeration Date | 2006-11-01 |
| Last Update Date | 2015-02-20 |