| NPI | 1891746707 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: CO 31351) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: UT 1823241205) |
| 207Q00000X Family Medicine (Licence: NM 89132) | |
| Enumeration Date | 2006-05-15 |
| Last Update Date | 2013-11-13 |