| NPI | 1689650897 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: CO CDR.0000029) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: IA 21186) |
| Enumeration Date | 2005-12-20 |
| Last Update Date | 2018-06-26 |