| NPI | 1578619193 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2083P0500X Preventive Medicine, Preventive Medicine/Occupational Environmental Medicine (Licence: CO DR.0047303) |
| Additional Taxonomies | 208D00000X General Practice (Licence: CO 47303) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: CO TL-2024) | |
| Enumeration Date | 2007-01-26 |
| Last Update Date | 2018-03-16 |