| NPI | 1518348010 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: CO DR.0057316) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: CO TL.0005745) |
| Enumeration Date | 2015-06-11 |
| Last Update Date | 2022-01-26 |