| NPI | 1790769230 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2083P0901X Preventive Medicine Public Health & General Preventive Medicine (Licence: CO 24912) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: CO 24912) |
| Enumeration Date | 2005-11-29 |
| Last Update Date | 2007-11-21 |