| NPI | 1437578762 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: CO DR.0067691) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: OH 35.128986) |
| Enumeration Date | 2014-04-15 |
| Last Update Date | 2024-05-01 |