| NPI | 1902167380 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: CO DR0058797) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: AZ R73451) |
| Enumeration Date | 2012-06-01 |
| Last Update Date | 2021-06-15 |