| NPI | 1871649368 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: CO 34732) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NC 2005-00115) |
| Enumeration Date | 2007-01-26 |
| Last Update Date | 2022-04-27 |