| NPI | 1740669514 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: AZ 008047) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: CO DR0057309) |
| 207Q00000X Family Medicine (Licence: UT 12227416-1204) | |
| Enumeration Date | 2015-05-26 |
| Last Update Date | 2024-09-02 |