| NPI | 1649381286 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NE 21619) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: CO 48150) |
| Enumeration Date | 2006-08-31 |
| Last Update Date | 2011-10-19 |