| NPI | 1699395780 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207QS0010X Family Medicine, Sports Medicine (Licence: MN 69921) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: CO DR.0070456) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2020-04-20 |
| Last Update Date | 2024-09-09 |