| NPI | 1104141670 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: CO 50150) |
| Additional Taxonomies | 207QS0010X Family Medicine Sports Medicine (Licence: CO 0050150) |
| Enumeration Date | 2010-03-29 |
| Last Update Date | 2017-12-27 |