| NPI | 1700827706 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NC 2010-01265) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: CO DR.0027990) |
| Enumeration Date | 2006-06-09 |
| Last Update Date | 2024-07-12 |