| NPI | 1265792238 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207QS0010X Family Medicine, Sports Medicine (Licence: CO DR.0057008) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: ID O-0857) |
| Enumeration Date | 2012-05-23 |
| Last Update Date | 2023-05-25 |