| NPI | 1295264158 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: CO DR.0061197) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: CO 0006650) |
| Enumeration Date | 2017-06-05 |
| Last Update Date | 2023-07-05 |