| NPI | 1659635662 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: CO DR.0063456) |
| Additional Taxonomies | 208D00000X General Practice (Licence: HI DOS1554) |
| Enumeration Date | 2012-06-25 |
| Last Update Date | 2020-03-31 |