| NPI | 1497980742 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NM MD2018-0796) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: CO DR 0052354) |
| Enumeration Date | 2009-05-15 |
| Last Update Date | 2018-11-12 |