| NPI | 1740471374 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: CO DR.0053132) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NM A-1643-11) |
| Enumeration Date | 2007-08-08 |
| Last Update Date | 2022-03-07 |