| NPI | 1871739938 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: CO 47485) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: CA 20A10545) |
| Enumeration Date | 2008-12-19 |
| Last Update Date | 2016-03-24 |