| NPI | 1871576991 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: CO DR.0026068) |
| Additional Taxonomies | 207QS0010X Family Medicine Sports Medicine (Licence: CO DR.0026068) |
| Enumeration Date | 2005-11-22 |
| Last Update Date | 2017-07-19 |