| NPI | 1720177678 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: CO 50997) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MI 4301073008) |
| Enumeration Date | 2006-10-11 |
| Last Update Date | 2013-08-08 |