| NPI | 1073925749 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: VA 0102204530) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: CO DR.0072257) |
| Enumeration Date | 2014-05-28 |
| Last Update Date | 2024-04-16 |