| NPI | 1912952730 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: CO 50916) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: FL ME63546) |
| 207Q00000X Family Medicine (Licence: AR C7149) | |
| Enumeration Date | 2006-05-23 |
| Last Update Date | 2013-10-28 |