| NPI | 1740578780 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: CO DR.0053523) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: TX BP10041425) |
| Enumeration Date | 2011-07-12 |
| Last Update Date | 2024-11-25 |