| NPI | 1417966425 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: KY 42890) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: CO 42609) |
| Enumeration Date | 2006-08-07 |
| Last Update Date | 2026-06-24 |