| NPI | 1720083140 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: CO DR.0062665) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: PA MD421712) |
| Enumeration Date | 2005-06-14 |
| Last Update Date | 2019-09-06 |