| NPI | 1689932659 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: CO DR0053011) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: ID M-12857) |
| Enumeration Date | 2012-04-27 |
| Last Update Date | 2019-07-31 |