| NPI | 1639434509 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: OR MD187028) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: CO 0066846) |
| Enumeration Date | 2012-07-06 |
| Last Update Date | 2021-08-18 |