| NPI | 1740607001 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NM A-2268-19) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: CO DR.0059119) |
| Enumeration Date | 2014-03-25 |
| Last Update Date | 2023-03-07 |