| NPI | 1962678516 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: CO 51103) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: CO 51103) |
| Enumeration Date | 2008-05-05 |
| Last Update Date | 2012-10-31 |