| NPI | 1437132859 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207QS0010X Family Medicine, Sports Medicine (Licence: CO 50399) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: CO 0050399) |
| 207QS0010X Family Medicine, Sports Medicine (Licence: NC 200301159) | |
| Enumeration Date | 2005-11-21 |
| Last Update Date | 2019-02-11 |