| NPI | 1790713139 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: CO DR.0066576) |
| Additional Taxonomies | 207QH0002X Family Medicine Hospice and Palliative Medicine (Licence: CO DR.0066576) |
| Enumeration Date | 2006-06-28 |
| Last Update Date | 2023-08-11 |