| NPI | 1366532236 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: CO CDRH.0047524) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MI 4301084817) |
| Enumeration Date | 2006-10-13 |
| Last Update Date | 2025-03-28 |