| NPI | 1609257690 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: CO DR.0066502) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: CO DR.0066502) |
| Enumeration Date | 2015-06-15 |
| Last Update Date | 2023-07-26 |