| NPI | 1346689213 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: CO DR.0069392) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: ID O-0963) |
| Enumeration Date | 2013-06-24 |
| Last Update Date | 2022-09-30 |