| NPI | 1235592676 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: CO DR.0063602) |
| Additional Taxonomies | 207QS0010X Family Medicine, Sports Medicine (Licence: CO DR.0063602) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: CO TL.0007062) | |
| Enumeration Date | 2016-04-02 |
| Last Update Date | 2023-02-14 |