| NPI | 1770514390 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: CO 49097) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: CA A73320) |
| 207Q00000X Family Medicine (Licence: SD 9701) | |
| Enumeration Date | 2006-07-05 |
| Last Update Date | 2016-06-23 |