| NPI | 1265690697 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: CO DR.0052069) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: WI 448) |
| 207R00000X Internal Medicine (Licence: IL 336.087795) | |
| Enumeration Date | 2008-06-02 |
| Last Update Date | 2025-03-28 |