| NPI | 1093126427 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: CO DR.0055887) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: CO TL0005132) |
| Enumeration Date | 2014-05-20 |
| Last Update Date | 2020-05-29 |