| NPI | 1093785032 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: CO DR.0057938) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NH 7074) |
| Enumeration Date | 2006-01-24 |
| Last Update Date | 2017-11-29 |