| NPI | 1912996505 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: CO DR.0023871) |
| Additional Taxonomies | 2084N0400X Psychiatry & Neurology, Neurology (Licence: CO DR.0023871) |
| 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: CO DR.0023871) | |
| Enumeration Date | 2005-10-17 |
| Last Update Date | 2018-06-15 |