| NPI | 1831406461 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: CO DR.0052701) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MI 4301096250) |
| Enumeration Date | 2010-09-02 |
| Last Update Date | 2024-07-09 |