| NPI | 1356674519 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: CO DR.0031167) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: OK 4023) |
| 207Q00000X Family Medicine (Licence: NM A-1267-04) | |
| Enumeration Date | 2009-09-04 |
| Last Update Date | 2023-07-26 |