| NPI | 1861463648 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: CO 39748) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: KS 04-13971) |
| 207Q00000X Family Medicine (Licence: MN 20189) | |
| Enumeration Date | 2006-01-30 |
| Last Update Date | 2023-03-07 |