| NPI | 1174599575 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207QS0010X Family Medicine Sports Medicine (Licence: CO DR.0064719) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NC 9901191) |
| Enumeration Date | 2006-02-24 |
| Last Update Date | 2024-01-23 |