| NPI | 1932259587 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: CO 48329) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: WI 39311) |
| Enumeration Date | 2007-01-12 |
| Last Update Date | 2013-02-26 |