| NPI | 1851575062 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: CO 23302) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: OH 35079489) |
| 207Q00000X Family Medicine (Licence: CA G68393) | |
| Enumeration Date | 2007-12-24 |
| Last Update Date | 2019-07-02 |