| NPI | 1669969085 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: CO DR.0066716) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MN 66237) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2018-04-20 |
| Last Update Date | 2023-02-02 |