| NPI | 1083032817 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: CO DR.0061165) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MO 2014018070) |
| 208000000X Pediatrics (Licence: MO 2014018070) | |
| Enumeration Date | 2014-03-29 |
| Last Update Date | 2019-07-11 |