| NPI | 1144204405 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: CO DR0071691) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: SC 22749) |
| 207Q00000X Family Medicine (Licence: MD D0091535) | |
| Enumeration Date | 2005-11-30 |
| Last Update Date | 2024-01-23 |