| NPI | 1851881122 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: CO DR.0067724) |
| Additional Taxonomies | 208600000X Surgery (Licence: AZ R76724) |
| Enumeration Date | 2018-05-13 |
| Last Update Date | 2022-03-01 |