| NPI | 1528555240 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MT 99499) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: CO TL.0007188) |
| Enumeration Date | 2018-04-18 |
| Last Update Date | 2021-07-28 |