| NPI | 1992167225 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207QS0010X Family Medicine, Sports Medicine (Licence: CO DR.0059082) |
| Additional Taxonomies | 207QS0010X Family Medicine, Sports Medicine (Licence: FL ME145478) |
| Enumeration Date | 2016-03-25 |
| Last Update Date | 2022-06-29 |