| NPI | 1508284431 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: CO DR.0068619) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: GA 078533) |
| Enumeration Date | 2014-03-28 |
| Last Update Date | 2022-04-23 |