| NPI | 1013941319 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: CO DR.0056166) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: TN 39996) |
| Enumeration Date | 2006-07-10 |
| Last Update Date | 2021-03-26 |