| NPI | 1982798310 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: FL 97817) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: CO DR.0052091) |
| Enumeration Date | 2006-10-02 |
| Last Update Date | 2024-02-13 |