| NPI | 1114077278 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208M00000X Hospitalist (Licence: CO DR.0050369) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: CO 50369) |
| 207QS0010X Family Medicine, Sports Medicine (Licence: CO 50369) | |
| Enumeration Date | 2007-01-11 |
| Last Update Date | 2026-09-09 |