| NPI | 1053767749 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NC 2019-01617) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: CO DR.0064081) |
| Enumeration Date | 2016-05-11 |
| Last Update Date | 2025-09-10 |