| NPI | 1700526761 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: CO DR.0071576) |
| Additional Taxonomies | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: CO DR.0071576) |
| Enumeration Date | 2022-03-29 |
| Last Update Date | 2025-06-24 |