| NPI | 1326254616 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: CO DR.0048125) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: MI 5101017280) |
| Enumeration Date | 2007-05-15 |
| Last Update Date | 2016-10-28 |