| NPI | 1568811024 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: AZ 59230) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: CO TL0006259) |
| Enumeration Date | 2016-06-06 |
| Last Update Date | 2025-01-31 |