| NPI | 1942362660 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: CO DR.0061703) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: OR MD 28042) |
| 207Q00000X Family Medicine (Licence: TN 41858) | |
| Enumeration Date | 2006-12-16 |
| Last Update Date | 2023-02-27 |