| NPI | 1861547572 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: CO DR.0036450) |
| Additional Taxonomies | 207QS0010X Family Medicine, Sports Medicine (Licence: CO 36450) |
| Enumeration Date | 2007-01-24 |
| Last Update Date | 2021-10-04 |