| NPI | 1548277593 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: CO DR.0047338) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NM 95-225) |
| Enumeration Date | 2006-08-02 |
| Last Update Date | 2022-09-29 |