| NPI | 1699743724 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207QA0000X Family Medicine, Adolescent Medicine (Licence: CO DR.0027612) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: CO 27612) |
| Enumeration Date | 2006-03-14 |
| Last Update Date | 2016-02-05 |