| NPI | 1326496019 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: CO DR.0062719) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: CO TL.0006189) |
| Enumeration Date | 2016-06-02 |
| Last Update Date | 2024-02-13 |