| NPI | 1669811683 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: CO DR.0058442) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: ME DO2541) |
| Enumeration Date | 2013-06-24 |
| Last Update Date | 2023-10-20 |