| NPI | 1740627488 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: CO DR.0061641) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: OH 34.011946) |
| Enumeration Date | 2013-06-03 |
| Last Update Date | 2018-12-27 |