| NPI | 1174017628 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: CO DR.0067880) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: SC LL52779) |
| Enumeration Date | 2018-06-19 |
| Last Update Date | 2022-08-15 |