| NPI | 1700046422 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: CO 30917) |
| Additional Taxonomies | 2083X0100X Preventive Medicine, Occupational Medicine (Licence: TX G9084) |
| Enumeration Date | 2008-06-16 |
| Last Update Date | 2020-07-28 |