| NPI | 1659324515 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: CO PA 1933) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: CT 001389) |
| Enumeration Date | 2006-05-19 |
| Last Update Date | 2011-10-03 |