| NPI | 1952470965 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: AZ 62774) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: CO DR.0071819) |
| Enumeration Date | 2006-11-06 |
| Last Update Date | 2024-06-22 |