| NPI | 1821409285 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207QS0010X Family Medicine, Sports Medicine (Licence: CO DR.0055915) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: CO TL0005149) |
| Enumeration Date | 2014-05-19 |
| Last Update Date | 2021-06-07 |