| NPI | 1891938684 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: CO 51084) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: CO CDRH0051084) |
| Enumeration Date | 2009-04-09 |
| Last Update Date | 2023-02-06 |