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 |