| NPI | 1316367832 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: CO DR.0070692) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: SC 390200000) |
| Enumeration Date | 2014-04-23 |
| Last Update Date | 2023-05-10 |