| NPI | 1861640468 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: CO DR.0050696) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: GA 003047) |
| 207Q00000X Family Medicine (Licence: GA 65508) | |
| Enumeration Date | 2008-09-08 |
| Last Update Date | 2015-11-25 |