| NPI | 1104315019 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: CO DR.0064282) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: CO TL.0007372) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: CO TL.0007372) | |
| Enumeration Date | 2018-05-07 |
| Last Update Date | 2021-06-11 |