| NPI | 1689894412 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: CO 48113) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: CA A99587) |
| Enumeration Date | 2007-04-26 |
| Last Update Date | 2021-06-18 |