| NPI | 1598082786 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: CO DR.0067200) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MN 54070) |
| Enumeration Date | 2010-04-27 |
| Last Update Date | 2024-12-11 |