| NPI | 1508146267 | 
|---|---|
| Entity Type | Individual | 
| Gender | Male | 
| Sole Proprietor ? | Yes | 
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: CO DR.0065134)  | 
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: OK 29396)  | 
| 208600000X Surgery (Licence: MD P26746)  | |
| Enumeration Date | 2011-08-25 | 
| Last Update Date | 2021-03-09 |