| NPI | 1750844544 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: CO DR.0069343) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: CO 69343) |
| Enumeration Date | 2019-04-09 |
| Last Update Date | 2025-05-09 |