| NPI | 1548836463 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: CO DR.0072775) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MI 4351047944) |
| Enumeration Date | 2021-06-01 |
| Last Update Date | 2024-06-15 |