| NPI | 1861459687 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MO 2014013679) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: CO 38965) |
| Enumeration Date | 2006-04-26 |
| Last Update Date | 2014-06-02 |