| NPI | 1982665568 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: CO 37249) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: CO CO37249) |
| Enumeration Date | 2006-03-31 |
| Last Update Date | 2008-04-30 |