| NPI | 1720254204 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: OR MD193883) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: CO 50120) |
| Enumeration Date | 2008-05-05 |
| Last Update Date | 2023-08-03 |