| NPI | 1285130815 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NC 2022-00797) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: CO DR.0063444) |
| Enumeration Date | 2018-04-03 |
| Last Update Date | 2026-01-22 |