| NPI | 1124367446 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: OH 35.139525) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: CO DR.0063581) |
| Enumeration Date | 2013-02-06 |
| Last Update Date | 2025-02-28 |