| NPI | 1639335060 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: CT 69857) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: CO DR.0050005) |
| 207R00000X Internal Medicine (Licence: CA 20A19217) | |
| 207R00000X Internal Medicine (Licence: MT 143638) | |
| Enumeration Date | 2008-08-05 |
| Last Update Date | 2024-09-08 |