| NPI | 1023438140 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: CO DR.0076486) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: LA 306658) |
| Enumeration Date | 2014-04-17 |
| Last Update Date | 2026-03-20 |