| NPI | 1205823549 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: CO DR.0051205) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: FL OS9027) |
| Enumeration Date | 2005-10-03 |
| Last Update Date | 2023-09-20 |