| NPI | 1669887360 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: CO DR.0055671) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: CO TL-05358) |
| Enumeration Date | 2014-06-23 |
| Last Update Date | 2021-06-17 |