| NPI | 1871857433 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NC 2014-00825) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: CO DR.0055596) |
| 207Q00000X Family Medicine (Licence: NC 182229) | |
| Enumeration Date | 2012-06-28 |
| Last Update Date | 2021-03-31 |