| NPI | 1346494887 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NM MD2014-0070) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: CO 47095) |
| Enumeration Date | 2008-11-11 |
| Last Update Date | 2024-10-10 |