| NPI | 1972866382 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: CO 0055641) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: VA 0116024892) |
| Enumeration Date | 2012-06-20 |
| Last Update Date | 2021-06-22 |