| NPI | 1528497393 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: CO DR.0056847) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: VA 0102203660) |
| Enumeration Date | 2013-11-02 |
| Last Update Date | 2025-06-21 |