| NPI | 1275020877 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: CO DR.0063494) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: CO TL.0007294) |
| Enumeration Date | 2018-04-18 |
| Last Update Date | 2023-04-21 |