| NPI | 1154315976 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: CO DR.0068519) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: IA 34212) |
| Enumeration Date | 2005-09-08 |
| Last Update Date | 2022-09-13 |