| NPI | 1790906261 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: CO DR46810) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: SD RL-0464) |
| Enumeration Date | 2007-05-01 |
| Last Update Date | 2021-10-01 |