| NPI | 1932164266 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: CO DR.0062245) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NE 18233) |
| 207Q00000X Family Medicine (Licence: SD 3344) | |
| Enumeration Date | 2006-04-19 |
| Last Update Date | 2024-08-16 |