| NPI | 1093200123 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: CO DR.0074372) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: LA 326218) |
| 207Q00000X Family Medicine (Licence: TN 65198) | |
| Enumeration Date | 2018-07-01 |
| Last Update Date | 2025-10-09 |