| NPI | 1487273462 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: WI 83701) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: CO DR.0067710) |
| Enumeration Date | 2020-04-10 |
| Last Update Date | 2024-06-13 |