| NPI | 1164656542 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: CO DR.0052763) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NE 6206) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2009-05-13 |
| Last Update Date | 2016-10-25 |