| NPI | 1366678542 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: CO DR.0049269) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: CO TL-3264) |
| Enumeration Date | 2009-06-02 |
| Last Update Date | 2020-03-26 |