| NPI | 1689679573 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: AR C6677) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: CO 49304) |
| Enumeration Date | 2005-06-16 |
| Last Update Date | 2017-01-10 |