| NPI | 1851822449 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: CO DR.0061036) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: CO 207Q00000X) |
| Enumeration Date | 2017-03-24 |
| Last Update Date | 2020-07-21 |