| NPI | 1962729467 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: CO DR.0069175) |
| Additional Taxonomies | 207QS0010X Family Medicine, Sports Medicine (Licence: KS 04-37142) |
| 207QS0010X Family Medicine, Sports Medicine (Licence: CO DR.0069175) | |
| Enumeration Date | 2010-04-23 |
| Last Update Date | 2022-11-04 |