| NPI | 1619201167 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: CA C167670) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NY 259762) |
| 207Q00000X Family Medicine (Licence: CO DR.0062946) | |
| Enumeration Date | 2009-09-30 |
| Last Update Date | 2023-04-18 |