| NPI | 1821291162 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: CO DR.0060966) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: TX M8504) |
| Enumeration Date | 2007-06-06 |
| Last Update Date | 2024-05-01 |