| NPI | 1538273644 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: CO DR.0059899) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NC 2006-00330) |
| Enumeration Date | 2006-08-18 |
| Last Update Date | 2022-12-16 |