| NPI | 1649624347 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: CO DR.0068173) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: TX BP10055352) |
| Enumeration Date | 2016-04-19 |
| Last Update Date | 2022-05-09 |