| NPI | 1205850880 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: CO DR.0047748) |
| Additional Taxonomies | 208D00000X General Practice (Licence: IN 01061512A) |
| Enumeration Date | 2006-07-27 |
| Last Update Date | 2023-08-02 |