| NPI | 1740241470 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: CO 0032906) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MO 2001025591) |
| Enumeration Date | 2006-03-31 |
| Last Update Date | 2023-05-25 |