| NPI | 1972587467 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: CO DR.0056015) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: CO DR.0056015) |
| 207Q00000X Family Medicine (Licence: SC 31295) | |
| 207Q00000X Family Medicine (Licence: NC 2008-01450) | |
| Enumeration Date | 2005-11-30 |
| Last Update Date | 2023-02-07 |