| NPI | 1720222813 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: CO DR.0057136) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: OH 35.120505) |
| 208000000X Pediatrics (Licence: OH 35.120508) | |
| Enumeration Date | 2009-04-21 |
| Last Update Date | 2020-12-16 |