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 | 2018-07-09 |