| NPI | 1578126231 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: WY 14910A) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: CO DR.0065118) |
| Enumeration Date | 2019-04-18 |
| Last Update Date | 2022-09-15 |