| NPI | 1235456013 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: CO DR.0063154) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NE 26536) |
| Enumeration Date | 2010-05-03 |
| Last Update Date | 2020-03-10 |