| NPI | 1639605330 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NC 2022-00540) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: CO TL.0006537) |
| Enumeration Date | 2017-05-02 |
| Last Update Date | 2022-07-22 |