| NPI | 1407111768 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207QA0505X Family Medicine Adult Medicine (Licence: CO DR.0019594) |
| Additional Taxonomies | 207QA0505X Family Medicine Adult Medicine (Licence: HI DOS-1349) |
| 207R00000X Internal Medicine (Licence: CO 19594) | |
| Enumeration Date | 2012-07-11 |
| Last Update Date | 2020-03-10 |