| NPI | 1679917827 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: CO DR.0056142) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: PA OT014972) |
| Enumeration Date | 2013-04-18 |
| Last Update Date | 2019-07-11 |