| NPI | 1508825753 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: CO DR.0053528) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: IA 28289) |
| Enumeration Date | 2006-03-17 |
| Last Update Date | 2024-02-19 |