| NPI | 1316074776 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: CO CDRH.0061297) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MA L-228504) |
| Enumeration Date | 2007-02-27 |
| Last Update Date | 2024-10-22 |