| NPI | 1548607328 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: CO DR.0061796) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: CA 132305) |
| 208D00000X General Practice (Licence: CA 132305) | |
| Enumeration Date | 2013-06-03 |
| Last Update Date | 2022-07-19 |