| NPI | 1578856217 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: CO DR.0067322) |
| Additional Taxonomies | 207QA0505X Family Medicine, Adult Medicine (Licence: SC 39317) |
| Enumeration Date | 2011-05-26 |
| Last Update Date | 2022-01-19 |