| NPI | 1407505803 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: CO DR.71519) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: CO TL.0009065) |
| Enumeration Date | 2022-03-22 |
| Last Update Date | 2025-10-08 |