| NPI | 1639153141 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: CO DR.0057784) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: OH 35-04-4451) |
| Enumeration Date | 2005-11-30 |
| Last Update Date | 2023-04-27 |