| NPI | 1730407321 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: CO DR.0050751) |
| Additional Taxonomies | 207QS0010X Family Medicine, Sports Medicine (Licence: CO 50751) |
| 207QS0010X Family Medicine, Sports Medicine (Licence: CO DR.0050751) | |
| Enumeration Date | 2010-05-06 |
| Last Update Date | 2023-05-30 |