| NPI | 1922094036 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: CO DR.0069807) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: WA MD00045718) |
| 207R00000X Internal Medicine (Licence: WY 7765A) | |
| Enumeration Date | 2005-09-23 |
| Last Update Date | 2023-03-16 |