| NPI | 1013219278 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: CO DR.0056040) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: CA 20A11445) |
| 207Q00000X Family Medicine (Licence: FL OS11654) | |
| Enumeration Date | 2010-11-21 |
| Last Update Date | 2016-07-19 |