| NPI | 1750022927 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: CO DR.0075194) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: SC 1750022927) |
| Enumeration Date | 2022-04-04 |
| Last Update Date | 2025-07-22 |