| NPI | 1588636211 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: CO 40172) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NM 2002-331) |
| Enumeration Date | 2006-02-06 |
| Last Update Date | 2020-12-16 |