| NPI | 1598946675 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: CO DR.0049131) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: NC 2022-02949) |
| 207R00000X Internal Medicine (Licence: TN 45322) | |
| Enumeration Date | 2007-11-17 |
| Last Update Date | 2026-01-20 |