| NPI | 1558527580 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: CO 50278) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NE 5786) |
| Enumeration Date | 2008-07-30 |
| Last Update Date | 2012-10-16 |