| NPI | 1659325710 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: CO DR.0054672) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NM MD2006-0704) |
| Enumeration Date | 2006-05-20 |
| Last Update Date | 2015-07-17 |