| NPI | 1023507035 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NE 3013) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: CO DR.0063543) |
| Enumeration Date | 2018-05-04 |
| Last Update Date | 2025-10-03 |