| NPI | 1851491070 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: WY TL5910) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: CO 35071) |
| Enumeration Date | 2006-09-25 |
| Last Update Date | 2019-10-09 |