| NPI | 1053948133 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: CO DR.0072756) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program |
| 207R00000X Internal Medicine (Licence: CO DR.0072756) | |
| Enumeration Date | 2020-03-26 |
| Last Update Date | 2024-07-15 |