| NPI | 1003120502 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207RS0010X Internal Medicine Sports Medicine (Licence: CO 0054273) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: CO DR0054273) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: CO TL-3680) | |
| Enumeration Date | 2010-07-27 |
| Last Update Date | 2024-08-26 |