| NPI | 1356083950 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: OR DO223872) |
| Additional Taxonomies | 208D00000X General Practice (Licence: CO DR.0073914) |
| 207Q00000X Family Medicine (Licence: CO TL.0009208) | |
| Enumeration Date | 2022-04-13 |
| Last Update Date | 2025-09-03 |