| NPI | 1730269853 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: CO 22404) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: WY 2890A) |
| Enumeration Date | 2006-10-16 |
| Last Update Date | 2018-01-12 |