| NPI | 1508252776 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: CO DR.0076805) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: OH 35.134261) |
| Enumeration Date | 2015-04-14 |
| Last Update Date | 2026-04-13 |