| NPI | 1700904406 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: AK 5493) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: CA A51581) |
| 207Q00000X Family Medicine (Licence: CO 29061) | |
| Enumeration Date | 2007-03-27 |
| Last Update Date | 2013-01-25 |