| NPI | 1215233440 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: CO DR.0062786) |
| Additional Taxonomies | 208D00000X General Practice (Licence: IN 02004259A) |
| Enumeration Date | 2011-02-05 |
| Last Update Date | 2019-10-28 |