| NPI | 1093151805 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: CO TL0004748) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: OR MD176889) |
| Enumeration Date | 2013-05-20 |
| Last Update Date | 2016-09-02 |