NPI | 1083274815 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 207Q00000X Family Medicine (Licence: CO DR.0071490) |
Additional Taxonomies | 207Q00000X Family Medicine (Licence: MO 2019020877) |
207Q00000X Family Medicine (Licence: NV 22458) | |
Enumeration Date | 2019-06-14 |
Last Update Date | 2025-02-04 |