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 |