| NPI | 1114410784 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NV SL1306) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: CO DR.0069622) |
| Enumeration Date | 2018-06-08 |
| Last Update Date | 2024-04-17 |