| NPI | 1295798981 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: CO DR.0032600) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: CO 32600) |
| Enumeration Date | 2006-04-11 |
| Last Update Date | 2014-04-29 |