| NPI | 1578511028 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: CO 46192) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: CO 46192) |
| 207Q00000X Family Medicine (Licence: OH 35086983) | |
| Enumeration Date | 2006-05-05 |
| Last Update Date | 2018-03-17 |