| NPI | 1851337984 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: WY 9504A) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: CO 27626) |
| Enumeration Date | 2006-06-20 |
| Last Update Date | 2015-09-09 |