| NPI | 1962473165 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: CO DR.0048752) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: OH 35. 074022) |
| Enumeration Date | 2006-01-27 |
| Last Update Date | 2023-12-22 |