| NPI | 1013234517 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: CO 49081) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: VA 0101250516) |
| 174400000X Specialist (Licence: NY 269663) | |
| Enumeration Date | 2010-04-23 |
| Last Update Date | 2016-11-23 |