| NPI | 1598986127 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: CO 59269) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: KS 6551) |
| Enumeration Date | 2007-05-01 |
| Last Update Date | 2023-07-03 |