| NPI | 1053666594 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NC 2023-03198) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: CO 4404) |
| Enumeration Date | 2012-07-20 |
| Last Update Date | 2024-01-15 |