| NPI | 1952984502 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: CO 74861) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NE 35936) |
| Enumeration Date | 2021-05-02 |
| Last Update Date | 2026-09-02 |