| NPI | 1609338896 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: CO DR.0071447) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NC 2022-02026) |
| Enumeration Date | 2019-04-05 |
| Last Update Date | 2023-07-31 |