NPI | 1871882837 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 207Q00000X Family Medicine (Licence: CO DR.0051633) |
Additional Taxonomies | 207Q00000X Family Medicine (Licence: SD 9131) |
Enumeration Date | 2011-03-30 |
Last Update Date | 2023-02-22 |