| NPI | 1356365118 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: CO DR.0056984) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: CT 021532) |
| Enumeration Date | 2006-07-26 |
| Last Update Date | 2016-08-22 |