| NPI | 1770922510 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: CO DR.0064165) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NE 1237) |
| Enumeration Date | 2013-06-14 |
| Last Update Date | 2026-07-06 |