| NPI | 1134573801 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: MT MED-PHYS-LIC-86200) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: WY 12324A) |
| 207R00000X Internal Medicine (Licence: CO DR.0063335) | |
| Enumeration Date | 2016-04-19 |
| Last Update Date | 2024-07-11 |