| NPI | 1487067591 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: CO DR0056980) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: AZ 54350) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: CO TL 0005256) | |
| Enumeration Date | 2014-06-05 |
| Last Update Date | 2021-02-11 |