| NPI | 1700958576 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MO 2012011164) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: CO 42149) |
| Enumeration Date | 2006-11-15 |
| Last Update Date | 2021-11-02 |