| NPI | 1891282646 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: AK 179707) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: CO TL.0007181) |
| Enumeration Date | 2018-04-17 |
| Last Update Date | 2023-12-29 |