| NPI | 1902936107 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208D00000X General Practice (Licence: CO 30464) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: CO 30464) |
| Enumeration Date | 2007-03-06 |
| Last Update Date | 2012-05-02 |