| NPI | 1841814209 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: OR MD217900) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: CO DR.0071463) |
| Enumeration Date | 2020-06-02 |
| Last Update Date | 2024-01-09 |