| NPI | 1770587529 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: CO DR.0061408) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: KY 30390) |
| Enumeration Date | 2005-06-09 |
| Last Update Date | 2019-12-04 |