| NPI | 1477119428 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: CO DR.0072762) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: PA OT019053) |
| Enumeration Date | 2019-05-15 |
| Last Update Date | 2024-08-02 |