| NPI | 1427439694 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: CO DR.0072394) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NV 22166) |
| Enumeration Date | 2015-06-14 |
| Last Update Date | 2024-05-21 |