| NPI | 1033180963 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MO 2020013701) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: AR E-2287) |
| 207Q00000X Family Medicine (Licence: CO DR.0076443) | |
| Enumeration Date | 2006-01-30 |
| Last Update Date | 2025-11-03 |