| NPI | 1598992521 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: CO DR.0058786) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: KS 0535852) |
| Enumeration Date | 2009-06-17 |
| Last Update Date | 2021-09-01 |