| NPI | 1568583722 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: CO 63204) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: PA MD-046657-L) |
| Enumeration Date | 2007-04-03 |
| Last Update Date | 2022-11-01 |