| NPI | 1871569053 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: CO DR.0054072) |
| Additional Taxonomies | 207QS0010X Family Medicine, Sports Medicine (Licence: CO DR.0054072) |
| 2083A0100X Preventive Medicine, Aerospace Medicine (Licence: CO DR.0054072) | |
| 2083P0901X Preventive Medicine, Public Health & General Preventive Medicine (Licence: CO DR.0054072) | |
| Enumeration Date | 2006-02-27 |
| Last Update Date | 2024-05-31 |