| NPI | 1710026703 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: CO CDRH.0056257) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: NM 2005-0367) |
| 207R00000X Internal Medicine (Licence: IA MD-46553) | |
| Enumeration Date | 2007-02-06 |
| Last Update Date | 2024-01-08 |