NPI | 1053723023 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 207QS0010X Family Medicine, Sports Medicine (Licence: CO DR.0058941) |
Additional Taxonomies | 207Q00000X Family Medicine (Licence: CO DR.0058941) |
Enumeration Date | 2014-05-27 |
Last Update Date | 2022-05-11 |