| NPI | 1003346305 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: CO DR.0065226) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: VA 0116030819) |
| 207Q00000X Family Medicine (Licence: VA 0101265694) | |
| Enumeration Date | 2017-06-19 |
| Last Update Date | 2024-07-05 |