| NPI | 1891732004 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: CO DR.0041923) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: FL ME154314) |
| Enumeration Date | 2006-05-31 |
| Last Update Date | 2026-08-13 |