| NPI | 1598051534 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: CO DR.0065169) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: IA 41287) |
| Enumeration Date | 2011-06-28 |
| Last Update Date | 2020-10-30 |