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 |