| NPI | 1215349642 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| 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 |