| NPI | 1093941775 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: CO 52743) |
| Additional Taxonomies | 208D00000X General Practice (Licence: CO DR.0052743) |
| Enumeration Date | 2009-06-08 |
| Last Update Date | 2021-02-02 |