| NPI | 1154799708 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: AZ 59568) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: CO DR.0062410) |
| Enumeration Date | 2015-09-11 |
| Last Update Date | 2024-04-09 |