| NPI | 1659695625 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: CO DR0055445) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: TX N5327) |
| 207Q00000X Family Medicine (Licence: AZ 005929) | |
| Enumeration Date | 2010-03-20 |
| Last Update Date | 2021-12-01 |