| NPI | 1750762373 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: CO DR.0068140) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: CA Not issued yet) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: OK 7248) | |
| Enumeration Date | 2015-06-10 |
| Last Update Date | 2022-05-10 |