| NPI | 1265993679 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: CO DR.0073770) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: AK 192062) |
| Enumeration Date | 2019-03-28 |
| Last Update Date | 2024-09-27 |