| NPI | 1952094864 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: KS 04-53595) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: CO TL.0009972) |
| Enumeration Date | 2023-05-29 |
| Last Update Date | 2026-09-08 |