| NPI | 1700229721 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: CA 20A14857) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: CO DR.0061948) |
| Enumeration Date | 2013-04-09 |
| Last Update Date | 2024-03-14 |