| NPI | 1881988541 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: CO DR0054115) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: TX BP10040640) |
| Enumeration Date | 2011-05-30 |
| Last Update Date | 2015-11-25 |