| 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 |