| NPI | 1841298767 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: LA 013611) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: CO DR.0063562) |
| Enumeration Date | 2005-07-13 |
| Last Update Date | 2023-07-31 |