| NPI | 1801281589 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: FL OS15695) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: CO DR.0069937) |
| Enumeration Date | 2015-03-31 |
| Last Update Date | 2025-01-10 |