| NPI | 1770165706 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MO 2023045060) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: CO DR.0069665) |
| Enumeration Date | 2021-04-28 |
| Last Update Date | 2024-08-07 |