| NPI | 1396884334 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: CO 48884) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NM 2004-0385) |
| Enumeration Date | 2007-02-06 |
| Last Update Date | 2021-04-22 |