| NPI | 1053362673 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: CO CDR.0001260) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: GU M-2158) |
| 207Q00000X Family Medicine (Licence: CA G87967) | |
| 207Q00000X Family Medicine (Licence: WY 13835C) | |
| 207Q00000X Family Medicine (Licence: TN 57363) | |
| Enumeration Date | 2006-05-16 |
| Last Update Date | 2022-01-13 |