| NPI | 1588616163 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: CO 35854) |
| Additional Taxonomies | 207QS0010X Family Medicine, Sports Medicine (Licence: CO 35854) |
| Enumeration Date | 2006-05-16 |
| Last Update Date | 2010-06-23 |