| NPI | 1497333983 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: CO DR.0077162) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: CA A183600) |
| Enumeration Date | 2021-03-29 |
| Last Update Date | 2026-07-07 |