| NPI | 1689834046 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: CO 0059366) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: AZ 005348) |
| Enumeration Date | 2008-06-10 |
| Last Update Date | 2024-08-26 |