| NPI | 1780991463 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: CO 45675) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: GA 25250) |
| Enumeration Date | 2010-09-02 |
| Last Update Date | 2010-09-02 |