| NPI | 1902134380 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: CO DR.0059515) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: FL os6664) |
| Enumeration Date | 2009-11-24 |
| Last Update Date | 2023-07-10 |