| NPI | 1083176697 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: CO DR.0074189) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: OH 35.145238) |
| 207Q00000X Family Medicine (Licence: OH 35.145238) | |
| Enumeration Date | 2019-04-02 |
| Last Update Date | 2025-09-10 |