| NPI | 1417010398 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: CO DR.0030257) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: CA G74480) |
| Enumeration Date | 2006-12-19 |
| Last Update Date | 2024-12-12 |