| NPI | 1811982788 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: CO 38831) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: TN 36078) |
| Enumeration Date | 2005-09-15 |
| Last Update Date | 2010-09-14 |