| NPI | 1619325180 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: ID MRM-1583) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: CO DR.0073631) |
| Enumeration Date | 2016-05-25 |
| Last Update Date | 2025-05-16 |