| NPI | 1356838809 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: CA A198470) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: CO DR.0066605) |
| Enumeration Date | 2018-04-20 |
| Last Update Date | 2025-02-01 |