| NPI | 1467911701 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: CO DR.0073005) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MA 279937) |
| 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: MA 279937) | |
| 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: CO DR.0073005) | |
| Enumeration Date | 2019-03-17 |
| Last Update Date | 2024-09-24 |