| NPI | 1194304683 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: LA 348414) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: CO DR.0072601) |
| Enumeration Date | 2021-04-03 |
| Last Update Date | 2025-11-07 |