| NPI | 1669549127 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: CO DR.0058834) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NM NM2006-0607) |
| Enumeration Date | 2006-11-29 |
| Last Update Date | 2024-11-15 |