| NPI | 1144519562 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: CO DR.0066028) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MO 2013030080) |
| Enumeration Date | 2011-04-06 |
| Last Update Date | 2021-07-09 |