| NPI | 1649218389 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: LA 326539) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: CO DR.0046419) |
| 207Q00000X Family Medicine (Licence: CA 20A9310) | |
| Enumeration Date | 2006-06-03 |
| Last Update Date | 2025-02-19 |