| NPI | 1043747181 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: WY 12957A) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: CO TL0006765) |
| Enumeration Date | 2017-05-19 |
| Last Update Date | 2024-03-27 |