| NPI | 1285737395 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207QS0010X Family Medicine, Sports Medicine (Licence: CO DR.0045755) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: CO 45755) |
| 207Q00000X Family Medicine (Licence: MO T2004016530) | |
| 207QS0010X Family Medicine, Sports Medicine (Licence: NM 000) | |
| Enumeration Date | 2006-09-06 |
| Last Update Date | 2022-07-21 |