| NPI | 1972588929 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: CO 0055900) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MA 226657) |
| Enumeration Date | 2005-12-13 |
| Last Update Date | 2018-05-16 |