| NPI | 1578645230 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: CO 48324) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: KS 31852) |
| Enumeration Date | 2006-10-20 |
| Last Update Date | 2011-05-18 |