| NPI | 1508009929 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: CO DR.0049253) |
| Additional Taxonomies | 207QS0010X Family Medicine, Sports Medicine (Licence: UT 8350096-1205) |
| 207QS0010X Family Medicine, Sports Medicine (Licence: CO DR.0049253) | |
| Enumeration Date | 2009-04-15 |
| Last Update Date | 2024-12-18 |