| NPI | 1891373213 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: CO DR.0072683) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: CO 0072683) |
| Enumeration Date | 2021-03-29 |
| Last Update Date | 2024-08-07 |