| NPI | 1720056336 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: CO DR.0061679) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: PA OS-004716-L) |
| Enumeration Date | 2006-03-09 |
| Last Update Date | 2022-06-14 |