| NPI | 1831572619 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: CO DR.0077990) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: SC 83783) |
| Enumeration Date | 2015-06-30 |
| Last Update Date | 2026-07-08 |