| NPI | 1588944516 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: CO 56009) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: CA A115152) |
| 207QS0010X Family Medicine, Sports Medicine (Licence: CO DR.0056009) | |
| Enumeration Date | 2011-08-22 |
| Last Update Date | 2023-08-23 |