| NPI | 1295013597 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: CO DR.0050631) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: CO TL3623) |
| Enumeration Date | 2011-08-03 |
| Last Update Date | 2021-05-13 |