| NPI | 1215551957 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: CO DR.0067858) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: CO TL.0008338) |
| Enumeration Date | 2020-05-28 |
| Last Update Date | 2023-04-27 |