NPI | 1215349642 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 207Q00000X Family Medicine (Licence: CO DR.0058113) |
Additional Taxonomies | 251E00000X Home Health (Licence: CO DR.0058113) |
207QS0010X Family Medicine, Sports Medicine (Licence: CO DR.0058113) | |
Enumeration Date | 2014-05-20 |
Last Update Date | 2021-10-05 |