| NPI | 1720540644 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: AZ 65920) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: CO DR.0071485) |
| 207R00000X Internal Medicine (Licence: KS 04-48682) | |
| Enumeration Date | 2019-04-01 |
| Last Update Date | 2024-03-15 |