| NPI | 1740357524 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: CO DR.0072652) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: PA MD067878L) |
| 207Q00000X Family Medicine (Licence: TX P4369) | |
| Enumeration Date | 2006-11-29 |
| Last Update Date | 2024-02-28 |