| NPI | 1972165918 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: CO DR.0069067) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: IL 125.075219) |
| Enumeration Date | 2019-06-30 |
| Last Update Date | 2024-03-08 |