| NPI | 1588628663 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: SC 86594) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: KS 04-28408) |
| 207Q00000X Family Medicine (Licence: CO 44051) | |
| Enumeration Date | 2006-04-14 |
| Last Update Date | 2021-09-16 |