| NPI | 1033301684 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: CO 47995) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: NY 245675) |
| Enumeration Date | 2007-08-16 |
| Last Update Date | 2013-11-05 |