| NPI | 1841644341 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: CO DR0058974) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: CO TL0005925) |
| Enumeration Date | 2016-04-20 |
| Last Update Date | 2019-05-09 |