| NPI | 1457880197 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: CO DR.0072270) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: TX U3473) |
| Enumeration Date | 2017-06-07 |
| Last Update Date | 2025-03-28 |