| NPI | 1124349675 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: CO DR.0052857) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NC 164464) |
| Enumeration Date | 2010-06-18 |
| Last Update Date | 2018-10-12 |