| NPI | 1528094075 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: CO DR.0071260) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: FL ME105086) |
| 207Q00000X Family Medicine (Licence: IL 036-090644) | |
| Enumeration Date | 2006-06-25 |
| Last Update Date | 2023-10-03 |