NPI | 1023213238 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 207Q00000X Family Medicine (Licence: CO DR0052240) |
Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: MO 2006016550) |
Enumeration Date | 2007-06-18 |
Last Update Date | 2021-08-05 |