| NPI | 1932468055 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: CO DR.0072994) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: VA 0101255786) |
| Enumeration Date | 2012-05-09 |
| Last Update Date | 2025-06-23 |