| NPI | 1902328883 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: CO 0005529) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: UT 10434311-1206) |
| Enumeration Date | 2017-07-12 |
| Last Update Date | 2018-09-21 |