| NPI | 1104069376 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: CO 50280) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MO 2008018823) |
| Enumeration Date | 2009-04-16 |
| Last Update Date | 2021-04-20 |