| NPI | 1952587750 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: AZ 4493) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: CO DR.0057286) |
| Enumeration Date | 2008-01-11 |
| Last Update Date | 2024-11-19 |