| NPI | 1154499234 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: CO DR0053168) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: KS 0421454) |
| Enumeration Date | 2006-11-30 |
| Last Update Date | 2023-02-03 |