| NPI | 1386897221 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: MA 249316) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: CO DR.0057517) |
| Enumeration Date | 2008-10-23 |
| Last Update Date | 2022-05-24 |