| NPI | 1437612678 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: CO DR.0065800) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: CO TL0007823) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: CO TL.0007823) | |
| Enumeration Date | 2019-04-12 |
| Last Update Date | 2022-12-16 |