| NPI | 1629357892 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: CO DR.0053162) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NC 172631) |
| Enumeration Date | 2011-08-05 |
| Last Update Date | 2024-11-25 |