| NPI | 1841398518 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: VA 0101239190) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: CO DR.0067413) |
| Enumeration Date | 2006-09-20 |
| Last Update Date | 2022-07-27 |