| NPI | 1063941086 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: CO DR.0065517) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: TX BP10061) |
| Enumeration Date | 2017-06-05 |
| Last Update Date | 2021-04-07 |