| NPI | 1154982254 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: CO DR.0069426) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: IL 125.075243) |
| Enumeration Date | 2019-06-28 |
| Last Update Date | 2022-08-15 |