| NPI | 1447665906 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: CO DR0062549) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: IA R10122) |
| 207RH0003X Internal Medicine, Hematology & Oncology (Licence: AZ 007210) | |
| Enumeration Date | 2014-06-24 |
| Last Update Date | 2020-06-22 |