| NPI | 1609850726 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: CO 47070) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: SD 5058) |
| 207Q00000X Family Medicine (Licence: NM A147008) | |
| Enumeration Date | 2005-12-01 |
| Last Update Date | 2021-05-04 |