| NPI | 1891732004 | 
|---|---|
| Entity Type | Individual | 
| Gender | Male | 
| Sole Proprietor ? | No | 
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: CO DR.0041923) | 
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: FL ME154314) | 
| Enumeration Date | 2006-05-31 | 
| Last Update Date | 2025-10-31 |