| NPI | 1124008164 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NM MD2019-0990) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: ID M 7253) |
| 207Q00000X Family Medicine (Licence: CO DR.0059746) | |
| Enumeration Date | 2006-01-17 |
| Last Update Date | 2020-06-26 |