| NPI | 1841428075 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: CO 50390) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: KY 45531) |
| Enumeration Date | 2009-06-25 |
| Last Update Date | 2018-08-23 |