| NPI | 1710973029 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NE 25348) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: CO DR.0058826) |
| Enumeration Date | 2005-09-22 |
| Last Update Date | 2019-09-24 |