| NPI | 1972174845 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: CO DR.0073744) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MI 5151015307) |
| Enumeration Date | 2021-07-01 |
| Last Update Date | 2026-01-21 |