| NPI | 1619590494 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: CO dr.0066821) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: CO Tl.0008449) |
| Enumeration Date | 2020-05-27 |
| Last Update Date | 2024-02-09 |