| NPI | 1811149685 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207RG0300X Internal Medicine, Geriatric Medicine (Licence: CO DR.0049886) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: CO DR.0049886) |
| 207Q00000X Family Medicine (Licence: WY 8019A) | |
| 207R00000X Internal Medicine (Licence: CO DR.0049886) | |
| Enumeration Date | 2008-10-10 |
| Last Update Date | 2021-12-02 |