| NPI | 1750425385 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: CO 24348) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: CO 24348) |
| 208D00000X General Practice (Licence: CO 24348) | |
| Enumeration Date | 2007-02-16 |
| Last Update Date | 2016-06-07 |