| NPI | 1336434059 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: CO DR.0056374) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: SC 33522) |
| Enumeration Date | 2011-06-10 |
| Last Update Date | 2021-05-19 |