| NPI | 1700173218 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: OR DO166841) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: CO TL4128) |
| Enumeration Date | 2011-07-05 |
| Last Update Date | 2014-11-24 |