| NPI | 1578982864 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: CO DR.0059617) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: WY 13615C) |
| Enumeration Date | 2014-04-15 |
| Last Update Date | 2021-06-22 |