| NPI | 1871892281 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: CO DR0059146) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: CO TL.0005999) |
| Enumeration Date | 2011-03-24 |
| Last Update Date | 2024-01-09 |