| NPI | 1801803259 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: CO DR.0062445) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: KS 05-31745) |
| Enumeration Date | 2006-08-01 |
| Last Update Date | 2019-05-09 |