| NPI | 1639276082 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NM MD2021-0641) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: CO 34759) |
| Enumeration Date | 2006-09-20 |
| Last Update Date | 2021-07-30 |