| NPI | 1790191864 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: CO 33336) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: CA G50288) |
| 207R00000X Internal Medicine (Licence: FL 133417) | |
| 207VG0400X Obstetrics & Gynecology, Gynecology (Licence: CO 33336) | |
| Enumeration Date | 2014-07-09 |
| Last Update Date | 2018-04-24 |