| NPI | 1083051155 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: CO DR.0065346) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: FL TRN19035) |
| 207R00000X Internal Medicine (Licence: WA MD60834908) | |
| Enumeration Date | 2013-05-30 |
| Last Update Date | 2021-06-23 |