| NPI | 1497168504 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: CO DR0055859) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: CO TL 0005261) |
| Enumeration Date | 2014-06-05 |
| Last Update Date | 2018-02-13 |