| NPI | 1114363942 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: CO DR.0054067) |
| Additional Taxonomies | 2083A0300X Preventive Medicine, Addiction Medicine (Licence: CO 0054067) |
| Enumeration Date | 2013-05-20 |
| Last Update Date | 2019-10-09 |