| NPI | 1295360006 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: CA A187859) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: CO DR.0066971) |
| Enumeration Date | 2020-03-12 |
| Last Update Date | 2025-07-16 |