| NPI | 1639550189 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: CO TL5837) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: CO TLTP.00013336) |
| Enumeration Date | 2015-06-10 |
| Last Update Date | 2015-06-17 |