| NPI | 1629115977 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MI 4301111226) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: CO DR.0045562) |
| Enumeration Date | 2007-01-30 |
| Last Update Date | 2026-01-08 |