| NPI | 1831177039 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: CO 26031) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: IA MD45722) |
| Enumeration Date | 2006-01-06 |
| Last Update Date | 2019-01-31 |