| NPI | 1710418587 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: CO DR.0064596) |
| Additional Taxonomies | 207QA0000X Family Medicine, Adolescent Medicine (Licence: CO A157647) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: OH SL458893) | |
| Enumeration Date | 2017-03-23 |
| Last Update Date | 2023-07-19 |