NPI | 1366586885 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 207Q00000X Family Medicine (Licence: CO DR.0056145) |
Additional Taxonomies | 101YM0800X Counselor, Mental Health |
207Q00000X Family Medicine (Licence: CO TL0004851) | |
Enumeration Date | 2007-02-17 |
Last Update Date | 2016-11-18 |