NPI | 1811086705 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 207Q00000X Family Medicine (Licence: CO DR.0042876) |
Additional Taxonomies | 207QS0010X Family Medicine, Sports Medicine (Licence: CO DR42876) |
Enumeration Date | 2006-10-11 |
Last Update Date | 2022-03-03 |