| NPI | 1578552675 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: CO 0067411) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: FL ME79030) |
| Enumeration Date | 2005-10-20 |
| Last Update Date | 2023-12-13 |