| NPI | 1407276611 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: VA 0101262915) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: FL TPME4627) |
| 207Q00000X Family Medicine (Licence: MI 4301508095) | |
| 207Q00000X Family Medicine (Licence: CO DR.0069739) | |
| Enumeration Date | 2014-04-27 |
| Last Update Date | 2023-12-20 |