| NPI | 1558509422 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: CA A103074) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: CO DR.0067522) |
| Enumeration Date | 2009-01-29 |
| Last Update Date | 2021-12-29 |