| NPI | 1952371718 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: CO DR.0060390) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: OK 19545) |
| Enumeration Date | 2006-01-25 |
| Last Update Date | 2021-06-19 |