| NPI | 1184088221 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208D00000X General Practice (Licence: CO DR.0066278) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: CO DR.0066728) |
| 208D00000X General Practice (Licence: TX s1200) | |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2016-04-05 |
| Last Update Date | 2023-05-01 |