| NPI | 1598188419 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: CO DR.0057353) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: FL UO3585) |
| Enumeration Date | 2014-01-28 |
| Last Update Date | 2021-06-21 |