| 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 |