| NPI | 1710171038 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: CA 104565) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: CO 43954) |
| Enumeration Date | 2007-08-29 |
| Last Update Date | 2008-07-16 |