| NPI | 1316987852 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: CO DR.0069761) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: FL ME90332) |
| 207Q00000X Family Medicine (Licence: CA G48415) | |
| Enumeration Date | 2006-06-06 |
| Last Update Date | 2025-01-06 |