| NPI | 1376668012 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: CO DR.0028258) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: CO 28258) |
| 207Q00000X Family Medicine (Licence: KS 05-45894) | |
| 2083X0100X Preventive Medicine, Occupational Medicine (Licence: NY 179939) | |
| Enumeration Date | 2007-03-20 |
| Last Update Date | 2022-03-10 |