| NPI | 1902919665 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: CO DR.0026295) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: CA A45383) |
| 261QU0200X Clinic/Center, Urgent Care | |
| 207P00000X Emergency Medicine (Licence: CA A45383) | |
| Enumeration Date | 2006-08-16 |
| Last Update Date | 2025-02-13 |